A study on the sustainability of employee medical insurance pooling fund:Multi-scenario simulation evidence from A Province
10.3969/j.issn.1674-2982.2025.11.006
- VernacularTitle:基于多情景模拟的A省职工医保统筹基金可持续性研究
- Author:
Jia-cheng ZOU
1
;
Shao-hua LI
Author Information
1. 东南大学公共卫生学院 江苏 南京 210009;安徽医科大学卫生管理学院 安徽 合肥 230032
- Publication Type:Journal Article
- Keywords:
Employee medical insurance;
Pooling fund;
Actuarial models;
Multi-scenario simulition
- From:
Chinese Journal of Health Policy
2025;18(11):39-47
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically assess the operating dynamics and sustainability of the employees'basic medical insurance pooling fund and provide evidence for policy optimization.Methods:Using Province A as a case study,a dynamic actuarial model grounded in the revenue-expenditure balance framework was constructed.Seven policy simulation scenarios were designed to forecast and compare fund trajectories from 2024 to 2050.Results:Without further policy intervention,the pooling fund faces a high risk of medium-to long-term imbalance.Fertility incentives and relaxed migration policies have limited short-term effects,serving primarily to slightly delay the emergence of deficits.Financing-sharing reforms significantly improve revenue quality,while provider-payment reforms effectively curb non-demographic cost growth.Gradual postponement of retirement strengthens fund sustainability by extending contribution periods and delaying benefit outflows.Cross-provincial instant settlement exerts the greatest pressure on fund expenditure.A comprehensive reform package delivers the most favorable and sustainable balance across revenue,expenditure,and accumulation.Conclusion:Future reforms should center on delayed retirement and provider-payment restructuring,coordinated with contribution-base expansion,demographic optimization,and strengthened oversight of cross-regional medical services,thereby forming a multi-policy collaborative governance framework to ensure the long-term sustainability of the pooling fund.
